Pilot Study Focused on Knowledge, Attitudes, and Health Access Behaviors of Psychiatric-Mental Health Nurses Regarding Suicide Prevention.

OBJECTIVE: The purpose of this pilot study was to evaluate the effect of a web-based education module on the knowledge, attitudes, and ratings of willingness to access help related to suicide prevention in psychiatric-mental health nurses. METHODS: A quasi-experimental pretest-posttest design was employed. Registered nurses from two academic health center units and a 239-bed Psychiatric Hospital were invited to participate. Scores on knowledge of suicide risk and prevention, attitudes, subjective norms, perceived behavioral control, and intent to seek help upon experiencing suicidal ideations were obtained before and after administering a 25-min web-based training. RESULTS: Twenty-nine participants completed the pre-survey, web-based education module, and post-survey. Significant increases from baseline in the scores on knowledge, attitudes, subjective norms, and intentions related to help-seeking behaviors for nurse suicide prevention were noted. Perceived behavioral control median scores increased but were not statistically significant. More than 40% of the participants reported having experienced suicidal thoughts. CONCLUSIONS: Further study is needed to determine contributors to this higher rate. Understanding the effectiveness of strategies to reduce nurse suicide can provide insights into building better nurse suicide prevention programs.

Promotion of Student Engagement Through the Application of Good Practices in Nursing Online Education.

The purpose of this article is to review Chickering and Gamson's principles of good practice in teaching and to illustrate their applicability to nursing online education delivery. An additional purpose is to present examples of teaching methods used by faculty to promote engagement in online education courses during the pandemic. The original 7 best practices in education, including ( a ) encourages contact between students and faculty, ( b ) develops reciprocity and cooperation among students, ( c ) uses active learning techniques, ( d ) gives prompt feedback, ( e ) emphasizes time on task, ( f ) communicates high expectations, and ( g ) respects diverse talents and ways of learning, remain evidence-based guidelines today. The authors recommend the addition of 2 new best practices: ( a ) incorporating assignment flexibility to meet student learning preferences; and ( b ) applying learning to real-life situations. Having evidence-based guidelines for supporting the role of a teacher in the online learning setting is of paramount importance.

Nursing Faculty Resilience During a Time of Disruption and Change.

ABSTRACT: Assessing the resilience level of nursing faculty during a time of unprecedented change in nursing education was the focus of this study. A descriptive cross-sectional survey that incorporated demographic data and the 10-item Connor-Davidson Resilience Scale was used. Participants ( n = 78) had an average resilience score of 32.6. No correlation was found between resilience and demographic variables such as age, years of teaching experience, and type of nursing program. Resilience is important because it helps faculty assimilate various protective factors and persist during times of rapid change.

Effectiveness of a Staff Resilience Program in a Pediatric Intensive Care Unit.

BACKGROUND: Compassion fatigue (CF) and secondary traumatic stress (STS) is prevalent in intensive care nurses, especially in pediatric intensive care nurses (PICU). CF, which includes STS and burnout, leads to reduced employee engagement and nursing turnover. PURPOSE: The purpose of this project was to evaluate the impact of a staff resilience program on nursing turnover, employee engagement and compassion satisfaction among nurses in a PICU. DESIGN AND METHODS: A retrospective pre-test and post-test design was used to evaluate the impact of a staff resilience program on turnover, engagement, and Professional Quality of Life (ProQOL), which measured compassion satisfaction and compassion fatigue. RESULTS: RN turnover was reduced and employee engagement was improved, although the differences were not statistically significant. The aggregate scores of the ProQOL indicated the RN's had low levels of CF with high levels of compassion satisfaction post implementation of the resilience program. Years of work experience was positively associated with compassion satisfaction and work engagement. CONCLUSIONS: Education regarding the prevention of CF and burnout coupled with interventions designed to promote resilience can be effective in reducing CF and in building compassion satisfaction. PRACTICE IMPLICATIONS: Doing an assessment of compassion fatigue and following up with the implementation of interventions to build staff resilience and promote psychological health can lead to positive outcomes, as demonstrated by the increase in work engagement and compassion satisfaction when burnout and CF decreased.

Work Values of Generation Z Nurses.

OBJECTIVES: To determine the work values of Generation Z nurses, a new generation in the current workforce. BACKGROUND: A new generation of nurses is now part of the nursing workforce. Generation Z nurses, born in 1995 (aged ≤24 years), will bring new expectations and ideals about life and work into healthcare work settings. METHODS: A descriptive, cross-sectional survey design was used to assess the work values of traditional baccalaureate Generation Z nursing students using the Lyons Work Values Survey. RESULTS: The work value component ranked most important by participants was social/altruistic, followed by instrumental/extrinsic, cognitive/intrinsic, and prestige. CONCLUSION: Helping people and having a job that is interesting and engaging while also offering job security and good benefits were the most important future Generation Z nurse work values.

Impact of Psychological Empowerment on Workplace Bullying and Intent to Leave.

OBJECTIVE: The objective of this study was to understand the association of psychological empowerment (PE) with workplace bullying and intent to leave among nurse leaders. BACKGROUND: Nurse leaders who experience bullying cope in varied ways. Some leaders have higher levels of empowerment and resilience, whereas others are more negatively impacted by bullying. METHODS: This study used a descriptive, cross-sectional survey design. Instruments used in the study included 2 PE tools: a bullying instrument and an intent-to-leave tool. The analysis tested for bivariate correlations and used analysis of variance to discern differences among nurse leaders. RESULTS: PE was negatively correlated with both bullying and intent to leave. Chief nursing officers and directors had significantly higher PE than did nurse managers, but there was no significant difference in intent to leave among the leader groups. CONCLUSIONS: PE may help protect against the impact of bullying. Continued development of leaders to strengthen their PE is needed.

Experience of nursing leaders with workplace bullying and how to best cope.

AIMS: The purposes of this study were to assess the exposure of nurse leaders in manager, director or executive-level roles to bullying and to identify strategies nurse leaders have found to be effective in dealing with colleagues or bosses who were bullies. BACKGROUND: Bullying is deliberate, negatively impacts the victim and is aggressive, intentional and frequent. Minimal information has been published about the bullying experiences of nurses that are in management and executive roles. METHODS: This study employed a descriptive, cross-sectional design. Participants included nurse managers, directors and executives from a US national nursing leadership organization that has approximately 9,700 members. RESULTS: Approximately 60% of participants experienced behaviours that can be categorized as bullying behaviours and 26% experienced severe workplace bullying. Confrontation, crucial conversation, leaving the organization and avoidance were the most frequently reported strategies for responding to bullying. CONCLUSION: Bullying is a significant workplace stressor for leaders at the manager, director and executive levels, and no easy solutions exist for addressing this serious health care workplace problem. IMPLICATION FOR NURSING MANAGEMENT: Bullying is "inappropriate, unacceptable behavior." Nursing leaders must identify and manage bullying behaviours and work together with applicable stakeholders to find and implement solutions.

Development of a Rubric for Evaluation of the DNP Portfolio.

A doctor of nursing practice (DNP) portfolio rubric for faculty to use when evaluating student portfolios and for students to use to critique their work is described. No rubrics or tools were found in the literature that provided guidelines to evaluate the extent to which portfolio exemplars meet American Association of Colleges of Nursing Essentials of Doctoral Education for Advanced Nursing Practice. The rubric provides criteria to evaluate whether portfolio documents demonstrate achievement of the DNP Essentials at a "developing, proficient, or exceptional" level. It is valuable tool to illustrate how the competencies outlined in the essentials are met within a DNP program.

Evaluation of the Impact of Discharge Clinic Follow-Up Interventions on 30-Day Readmission Rates.

Care transition programs can result in cost avoidance and decreased resource utilization. This project aimed to determine whether implementation of a discharge clinic, referral to a community paramedicine program, or a second postdischarge call affected 30-day readmission rates. This single-center retrospective exploratory design study included 727 discharged patients without access to a primary care provider who were scheduled for a discharge clinic transitions appointment. Readmission rates were 17.7% for those who completed a discharge appointment and 24.7% for those who did not; 4% for those completing a second postdischarge call and 26% for those who did not; and 11.1% for those referred to a community paramedicine program and 24.9% for those not referred. A completed discharge clinic appointment resulted in 36% lower odds of readmission. A completed discharge clinic appointment was effective in reducing 30-day readmission rates as was a follow-up call.

The DNP project: Two decades of impact.

ABSTRACT: Twenty years ago, pioneer Doctor of Nursing Practice (DNP) program students completed the first DNP projects. Today, DNP projects remain a requirement for graduation. This article illustrates how the DNP project can be integrated throughout the DNP curriculum to maximize effectiveness and promote the introduction, reinforcement, and evaluation of competencies in the new American Association of Colleges of Nursing Essentials.

Assessing the Value of Huddle Implementation in the Perioperative Setting.

Communication is essential for safe, effective patient care. In perioperative services, where interdisciplinary teamwork is crucial, communication breakdowns may lead to increased errors, decreased staff member satisfaction, and poor team performance. This process improvement project focused on instituting perioperative huddles for two months and measuring the effect that they had on staff members' satisfaction, engagement, and communication effectiveness. We used validated, Likert-style survey tools to gauge participants' satisfaction, level of engagement, communication practices, and opinions about the value of huddles before and after implementation, in addition to an open-ended descriptive question in the postsurvey. Sixty-one participants completed the presurvey and 24 participants completed the postsurvey. Scores across all categories increased post huddle implementation. Benefits of the huddles noted by participants included timely and consistent messaging, sharing essential information, and increased feelings of connection between perioperative leaders and staff members.

Celebrating over 20 years: Outcomes from the first doctor of nursing practice program.

The first Doctor of Nursing Practice (DNP) program was opened at the University of Kentucky College of Nursing (UKCON) in 2001. As the CON celebrates 20 plus years of DNP education, leaders decided to do an assessment of the accomplishments and outcomes from the work of graduates. The purpose of this study was to delineate the achievements, outcomes and perception of the impact of graduates from the UKCON DNP program and assess the correlations of specific "perception of impact" variables. DNP graduates from 2005 to 2021 (n = 348) received an email about the study and a link to the survey. Ninety graduates who resided in 14 states responded. Over 84 % of participants indicated that their DNP degree helped them stand out as a leader. Participants reported that having a DNP education increased their knowledge and expertise in multiple areas, including how to lead, to influence, and to improve outcomes within their organizations. Narrative feedback related to top achievements since graduation included career advancement/promotion (n = 22), improving patient care quality/implementation of evidence-based initiatives (n = 21), and becoming a better leader (n = 19). This study illustrated the broad return on investment and the quantification of value that a DNP education brings, both to practice and academia.

Impact of Case Review Debriefings on Moral Distress of Extracorporeal Membrane Oxygenation Nurses.

BACKGROUND: Moral distress occurs when nurses know the ethically correct action to take but are restrained from taking it. Moral distress is prevalent in nurses who work in intense stress situations, as do extracorporeal membrane oxygenation nurses. LOCAL PROBLEM: Nurses who work in critical care settings have higher levels of moral distress than nurses who work in other practice areas. The purpose of this project was to evaluate the effectiveness of case review debriefings on moral distress of extracorporeal membrane oxygenation nurses. METHODS: Thirty-nine critical care registered nurses with specialty training in extracorporeal membrane oxygenation were invited to participate in this clinical improvement project. The intervention consisted of 2 case review debriefings. The Moral Distress Scale-Revised and the Moral Distress Thermometer were used to measure long-term and acute (short-term) moral distress. RESULTS: Of a potential range of 0 to 336, the mean Moral Distress Scale-Revised score was 134.0 before intervention and 131.8 after intervention. The frequency of experiencing moral distress did not change after intervention, but the level of moral distress increased after intervention. Moral Distress Thermometer scores decreased for 80% of participants and increased for 20%. Five items related to perceptions of prolonging death and suffering were the most frequent causes of moral distress. CONCLUSIONS: Developing strategies and providing opportunities to mitigate moral distress are crucial to a healthy future nursing workforce. Implications include the potential for improved patient care, decreased turnover rates and costs, and improved nurse satisfaction rates.

Using unfolding case scenarios to promote clinical reasoning for nurse practitioner students.

ABSTRACT: This article describes how an unfolding case study can be used to promote the development of clinical reasoning through students' self-reported perceptions, although at the same time facilitating collaboration among providers from various specialties. An unfolding case (evolving case) provides sequential information about a patient's illness trajectory as they experience the illness and related symptomology. An unfolding case study was implemented during a college skills laboratory immersion experience for 33 nurse practitioner (NP) students who were in their final year of the NP program. Students were invited per email to complete a confidential REDCap survey after the case presentation and discussion. Twenty-three students completed the survey. More than half of the students (52%) stated the review of the unfolding case offered "significant learning value" and 78% rated the unfolding case as being "very to extremely" helpful in creating opportunities for critical thinking and engagement in clinical reasoning. Implementing unfolding case studies in NP student program curricula promotes critical thinking, clinical reasoning, and allows opportunities to engage in interprofessional collaboration.

Strengthening Professional Values of Doctoral-Level Nursing Students.

Introduction: Multiple recent critical societal/world events have impacted nurses' beliefs and emphasized the importance of the standards of behavior that frame nurses' professional values. Objectives: This study focused on the professional values of students in a Doctor of Nursing program (DNP), including the relationship between professional values, time in program, and intentions to participate in professionalism-focused activities. Methods: From fall 2019 through Spring 2021, 227 participants were invited to participate in this study through the completion of an online survey at several points in time. The survey contained various demographic variables, items from the Nurses Professional Values Scale-3 representing the dimensions of caring, activism, and professionalism, and Likert scale items that measured intentions to participate in professionalism-focused activities. Results: The overall mean NPVS-3 score was 118.30 (out of a possible range of 28-140). The highest mean score among the three dimensions was for caring (45.38), followed by activism (40.20) and then professionalism (32.71). Students indicated high intentions to participate in activities focused on professionalism (5.77 on a scale of 1 to 7). A moderate correlation between intentions and professionalism (r = .44, p < .0001) was noted. The association of intentions to caring and activism was weaker but significant (r = 0.26; p = .012) and (r = 0.37; p = .0003), respectively. Conclusion: DNP curricular efforts can strengthen nurses' professional values by focusing on the development of critically important professional attributes. Nurses, especially those who have a doctoral-level education, need to have strong professional values and understand the importance of their voice and impact as a leader in the profession.

Intentions to advance professional identity attributes among DNP students: The make it POP series leadership pilot program study.

BACKGROUND: Make It POP (Pathway Optimizing Professionalism) Series (MIPS) leadership educational sessions were developed and taught by the Dean as a curricular focus on professionalism for Doctor of Nursing Practice (DNP) students. PURPOSE: Evaluating the association between Behavioral Beliefs, Normative Beliefs, Control Beliefs, and Intention to advance professional identity and values was a focus of this study. A secondary focus was to discern whether these Belief measures and attendance to the MIPS education series were predictive of Intention to increase professional identity and values. METHOD: Over a two-year period, 227 students were invited to attend the MIPS courses, which included four once per semester sessions. Students were invited to complete a survey structured around the tenants of the Theory of Planned Behavior prior to attending the MIPS and following each session; 91 students completed the survey at least once. RESULTS: A significant relationship was not noted between attendance to one or more MIPS sessions and Intention to advance professional identity and values. Behavioral Beliefs and Control Beliefs had the strongest associations with Intentions, but normative beliefs were not significantly associated with Intentions. CONCLUSION: Integrating curricular innovation with meaningful engagement and reflection in DNP education may advance DNP student's commitment for sustained professional growth.

The effect of amino acid-oral rehydration solution (Enterade®) on chemotherapy related diarrhea and quality of life in solid tumor cancer patients: A non-randomized experimental study.

PURPOSE: The purpose of this study was to evaluate use of a proprietary amino acid-oral rehydration solution (AA-ORS) known as Enterade® to reduce the severity of chemotherapy related diarrhea (CRD), to improve patient reported Quality of Life (QOL), and to reduce treatment holds, delays, dose modifications, prevention of weight loss, and subjective improvement of associated gastrointestinal mucositis physical symptoms. METHODS: An experimental pilot study without randomization in a single population with two separate measurements over time was performed in a National Cancer Institute (NCI) designated cancer center in the South-Central United States. The variables included sociodemographic data, cancer diagnosis, chemotherapy treatment regimens, Common Terminology Criteria for Adverse Events (CTCAE) v5.0 grade of diarrhea, stool consistency using the Bristol Stool Scale, use of antidiarrheals, associated gastrointestinal mucositis symptoms affecting QOL, and QOL measured with the Functional Assessment of Chronic Illness Therapy-Diarrhea survey. RESULTS: A total of 22 participants enrolled in the study. Sixteen completed both the pre-survey and post survey. A statistically significant difference was not found between the patient's subjective report of quality of life when comparing pre and post survey responses. There was a statistically significant improvement from baseline in the QOL questions specific to bowel concerns due to diarrhea with a mean pre-survey response score of 35.3 versus a post survey score of 29.2 (p = .003). There was a reduction in the CTCACE grade of diarrhea demonstrating a reduction in the frequency of stools per day (p = .001) and a change in the consistency of stools moving from watery to more formed stools using the Bristol Stool Scale (p = .049). CONCLUSION: Use of AA-ORS in this study was found to be useful in the reduction of CRD in patients receiving systemic oncology therapies. This study needs to be replicated with a larger, more inclusive sample size to further support the use of AA-ORS in the reduction of CRD and QOL.

Development and validation of 11 symptom indexes to evaluate response to chemotherapy for advanced cancer.

Recent guidance from the FDA discusses patient-reported outcomes as end points in clinical trials. Using methods consistent with this guidance, the authors developed symptom indexes for patients with advanced cancer. Input on the most important symptoms was obtained from 533 patients recruited from NCCN Member Institutions and 4 nonprofit social service organizations. Diagnoses included bladder, brain, breast, colorectal, head and neck, hepatobiliary/pancreatic, kidney, lung, ovarian, and prostate cancers and lymphoma. Physician experts in each of these diseases were also surveyed to differentiate symptoms that were predominantly disease-based from those that were predominantly treatment-induced. Results are evaluated alongside previously published indexes for 9 of these 11 advanced cancers that were created based on expert provider surveys, also implemented at NCCN Member Institutions. Final results are 11 symptom indexes that reflect the highest priorities of people affected by these 11 advanced cancers and the experienced perspective of the people who provide their medical treatment. Beyond the clinical value of such indexes, they may also contribute significantly to satisfying regulatory requirements for a standardized tool to evaluate drug efficacy with respect to symptomatology.

Professional values and role socialization of new NPs.

ABSTRACT: This cross-sectional study focuses on assessing factors related to role socialization of new NPs. Participants identified caring as the most important professional value, followed by activism and professionalism. Role socialization factors including a sense of belonging and forming professional identities were higher for experienced NPs.

Effect of Clinical Reasoning Seminars on Medical-Surgical Specialty HESI Examination Scores.

BACKGROUND: Clinical reasoning and clinical judgment have been identified as essential skills for the delivery of quality patient care. PURPOSE: The purpose of this study was to determine the impact of clinical reasoning seminars (CRSs) on medical-surgical specialty HESI examination scores of high-risk students. METHODS: A retrospective correlational design was used for this study, which involved a review of medical-surgical HESI scores for 115 junior-level baccalaureate nursing students who were identified as academically high-risk and who participated in a series of CRSs. RESULTS: The participation in CRSs by high-risk students did not have a statistically significant impact on the medical-surgical HESI scores. Students who attended CRSs, however, had a higher mean medical-surgical HESI score than students who did not attend any CRSs. CONCLUSION: Although statistical differences were not found, it appears that high-risk students may have benefitted from participation in CRSs.